STIs | Sydney gynaecologist Dr Anu Mahadik

STIs

STI testing | Gynaecologist Sydney | Dr Anu Mahadik

What are STIs?

STI stands for Sexually Transmitted Infection. There are many different types that are caused by viruses, bacteria or parasites. Common STIs include herpes, chlamydia, gonorrhea and syphilis among others.

STIs are common and largely treatable. Anyone who is sexually active can catch an STI, especially if you do not practice safe sexual practices. Sometimes STIs are contracted during pregnancy and birth, or from sharing needles.

How do you get an STI?

STI stands for Sexually Transmitted Infection. There are many different types that are caused by viruses, bacteria or parasites. Common STIs include herpes, chlamydia, gonorrhea and syphilis among others.

STIs are common and largely treatable. Anyone who is sexually active can catch an STI, especially if you do not practice safe sexual practices. Sometimes STIs are contracted during pregnancy and birth, or from sharing needles.

Do I have an STI? How do I know?

You cannot diagnose an STI yourself. You need to see your GP for a test. They conduct these tests everyday, so there is no need to be embarrassed. It is better to have a test so that you can treat an STI. Some STIs can cause infertility if not treated, or you can pass them on to your sexual partners, so it is vital to have tests.

What are the symptoms of STIs?

Each STI has different symptoms. Sometimes there are no symptoms at all. Typical symptoms include:

  • Unusual discharge
  • Pain during urination
  • Rashes, warts, blisters, sores or ulcers on the gential area
  • Pain


Many STIs have no obvious symptoms which is why you should have regular sexual-health checkups if you have multiple partners.

STIs can be serious if left untreated and lead to infertility, chronic pelvic pain and risk of having an ectopic pregnancy (pregnancy in the tubes rather than in the uterus).

If you think you may have, or have contracted an STI there is no need to be embarrassed. You should talk to your GP to have a check-up – even if you don’t have any signs of symptoms yet. You should do this if you have had unprotected sex with a new partner or have been informed by a partner they have been diagnosed with an STI. If you have genital symptoms you should see your doctor, but remember that this may not always be an STI.

Most STI’s are preventable by using barrier protection methods such as condoms and female condoms. There are vaccines to prevent hepatitis B and HPV. While these prevent the contraction of these diseases you should still always use contraception to protect yourself from other STIs and against pregnancy.

Even if you don’t have any symptoms, you should get tested for an STI if;

  • You have had sexual contact without a condom with a partner when you don’t know when they had their last STI test
  • You have had a sexual experience with a new or casual partner (with or without a condom)
  • You suspect your partner has had other sexual partners
  • You have had any unwanted to non-consensual sexual contact
  • You have had sexual contact in a country where HIV or other STIs are common
  • A sexual partner tells you they have been diagnosed with an STI
  • If you are planning to have a baby to ensure STIs aren’t passed on to them


How often you should have STI tests depends on your personal sexual practices and risk behaviours. Even if you always use condoms it is a good idea to have a yearly sexual health check as condoms do not provide 100% protection against STIs.

Many STI tests nowadays usually involve only a urine test. Rapidly blood testing is available for others. Specific details are provided under each STI below.
If you are diagnosed with an STI you will need to contact every sexual partner you have had in the past 6 months so that they can be tested and also have treatment if needed. While you may feel awkward about this, many people will prefer to be told they might have an STI so that they can be tested and further reduce the spread. It is possible to contact the partners anonymously via the sexual health clinic.

The treatment depends on the STI that you have. Options include:

  • Antibiotics (for chlamydia, gonorrhoea and syphilis). This will be a combination of antibiotics and can be given as tablets or via a drip in the arm if the infection is severe.


Viral STIs do not currently have cures (herpes, hepatitis, HPV and HIV). However there are treatments to control the viral load in your body and prevent symptoms. These are described under each STI below.

STI testing | Sydney gynaecologist Dr Anu Mahadik

STI management | Gynaecologist Sydney | Dr Anu Mahadik

Understanding different STIs and how to manage them

This section describes each STI, how to test for them and how to manage them.

Chlamydia

Chlamydia is a very common STI that is caused by a bacteria.
Many people with chlamydia (8 out of 10) do not realise that they have it as they have no symptoms. Women under 25 are more at risk of chlamydia. Chlamydia is preventable with barrier-contraceptives.
Even if you do not have symptoms chlamydia can infect the cervix and spread to the uterus and fallopian tubes. This can cause pelvic inflammatory disease (PID), chronic pelvic pain and call lead to infertility or ectopic pregnancy. If you pass chlamydia on to your baby during birth they can have eye or lung infections or even blindness.

If you do have symptoms of chlamydia, they include:

  • Burning with urinating
  • Unusual vaginal discharge (commonly green or yellow)
  • Bleeding or spotting between periods
  • Lower abdominal pain
  • Pain or discomfort during sex
  • Bleeding after sex
Chlamydia is now usually diagnosed through a urine test, however your doctor may take a cotton swab from your vagina, cervix or anus. You will have to tell any partners that you have been diagnosed with chlamydia so they can be tested and treated. If you have a regular partner your doctor may give you an extra prescription so they can be treated immediately too.
If detected early, chlamydia is treatable with a single dose of an antibiotic. If it has developed into PID a longer course of antibiotics will be needed. After 3-months it is recommended that you have another chlamydia test.
You can get chlamydia multiple times – if you have had it once you are not immune from getting another infection.

Gonorrhea

Gonorrhoea is a bacterial STI. It typically impacts the genital area, although it can also infect the throat or anus. It is easily transmittable during vaginal sex, but can also be spread via oral or anal sex. Condoms help prevent contracting gonorrhoea.

Like chlamydia, you may experience no symptoms with gonorrhoea. This means you may be spreading it unknowingly. This is why it is common. If you have symptoms, they can include:

  • Unusual vaginal discharge
  • Pain during urination
  • Pain during sex
  • A sore throat (if gonorrhoea in the throat)


PID causes pain, inflammation, heavy and painful periods, fever and if left untreated increases the risk of infertility.There are often no symptoms, you should have regular tests especially if you have recently changed sexual partners and have had unprotected intercourse.

Gonorrhoea testing involves taking a urine test, or a swab from the cervix.
Gonorrhoea is treatable with antibiotics, however there are some strains that are antibiotic-resistant (especially if contracted overseas – tell your doctor if you have recently travelled). You may need to be tested again after 2-weeks to make sure that antibiotics worked. You should avoid sexual contact, even protected, until this follow up test. You should also have another test after 3-months to check the gonorrhoea has not come back.
You can get gonorrhoea more than once.

Herpes

Genital herpes are a common (1 in 8) STI that are caused by the herpes simplex virus (HSV). There are 2 types of HSV:

  • HSV1 – more commonly oral herpes (cold sores) but can spread to the genitals through oral sex
  • HSV2 – more commonly in and around the genitals


Herpes is very common and 80% are unaware that they have it. It can take weeks or years after being exposed to HSV for symptoms to appear, if at all. Because of this, herpes spreads widely. Herpes is spread by skin-to-skin contact during vaginal, oral or anal sex. You should not have sexual contact with someone if they have visible sores, even with protection.
Pregnant women may transmit herpes to their babies.

Like many other STIs, people with genital herpes may not be aware they have the infection as they have no symptoms. People with herpes have ‘episodes’ of symptoms. The first episode causes considerable pain and distress. Symptoms include:

  • Flu-like symptoms (headaches, aches and pains in the back and legs, enlarged glands, a general feeling of being unwell)
  • Itching or tingling
  • Redness or a rash
  • Small cracks in the skin
  • Small blisters around the genitals that break open to form painful ulcers
  • Pain and swelling which may cause difficulty passing urine
Your doctor will take a swab of the affected area to confirm the diagnosis. You may be sent for a blood test.
There is no cure for herpes but antiviral medication can help reduce the severity of symptoms, the number of recurrences and reduce the risk of spreading them. When you have symptoms you can treat them by taking pain medication, using topical anesthetic ointments or bathing the area with a warm salt water solution.
Herpes is a lifelong condition.
Herpes is a lifelong condition.

Typically recurrences are less painful and shorter than the first episode. Over time episodes become less and less frequent and may eventually stop all together. Infections caused by HSV1 are less likely to reoccur in the genitals. Recurrences may be triggered by:

  • Stress
  • Low immunity including cancer treatment
  • General illness
  • Menstruation
  • Sexual activity
Herpes is the most contagious during ‘viral shedding’. This often occurs while you have an episode – having a sore, blister, ulcer or skin split means you can spread herpes in skin-to-skin contact.
Herpes itself does not impact your ability to fall pregnant – you just shouldn’t have sex when you have visible lesions or symptoms. You should discuss this with your doctor

Syphilis

Syphilis is an STI caused by a bacterium. It is transmitted through close skin-to-skin contact and is highly contagious when syphilis sores or rashes are present. It is spread through sexual contact and to babies during birth.

Syphilis has serious health problems if left untreated, however it is easy to cure if found early. While it is rare in Australia, the numbers are growing. You should still get tested as soon as possible if you think you have syphilis. You should also stop having sex until you are tested as it is highly contagious.

If you have been exposed to syphilis it can take between 10 days and 3 months to develop symptoms. Untreated syphilis can be fatal or lead to chronic heart or brain disease. The treatment is very effective. If you are at an increased risk of syphilis you should have regular screening.

There are three different stages of syphilis and the symptoms are different at each stage. You are only infectious in the first and second stages.

  • Stage 1 (4 to 12 weeks) : Many people do not realise they have syphilis during the first stage as they may not have any symptoms, or they have sores but do not notice. Sores can be difficult to notice if they are inside the mouth, vagina or cervix and they often only occur as a single sore. As they are usually painless and heal within a month without any treatment it can be difficult to know.
  • Stage 2 (12 weeks – 2 years) : During the second stage of syphilis you may have:
    1. A red rash on the palms of your hands or soles of your feet. This rash is contagious
    2. Swollen lymph nodes
    3. Hair loss
    4. Pain in the joints
    5. A flu like illness
  • Stage 3 (10 – 30 years after initial infection) : In the third stage of syphilis you may develop severe brain or heart complications. Syphilis is not infectious at this point. It is serious, but it is still treatable.
Syphilis is diagnosed through a blood test or a swab if sores are present.
Syphilis is treatable with penicillin or other antibiotics if you are allergic. Early treatment helps stop the spread of syphilis. You should avoid sexual contact until you have completed your full course of treatment.

You can catch syphilis more than once.

Sydney Obstetrician Norwest and St George Private Hospitals

Consulting at Norwest and St George Private Hospitals

My consulting rooms are at Burbank Place, Norwest which is near Norwest Private Hospital. If you are preparing for your antenatal care and looking for the best and most suitable solution, you can count on my practice to help you. If you live northwest of Sydney CBD, or near the M2 or M7, you may find my practice in Norwest suitable for your antenatal care consultations.

If you live in the Sydney CBD, or south of Sydney, you may be best served by coming to my rooms in Kogarah, at St George Private Hospital Medical Suites.

I come from a family of doctors and it has always been my intuitive first choice to become an Obstetrician and Gynaecologist. I basically grew up in it, with my father being one of the co-founders of a series of IVF clinics in India. Care for mothers and the babies they are expecting has always been my first nature and I am grateful for being able to serve my patients in their journey.
So if you are in that phase where you are not sure how to choose a private obstetrician in Sydney, let’s have a chat so we can plan your antenatal care together.

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